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Do Not Resuscitate (DNR) Wisconsin

Document Name

Do-Not-Resuscitate Order

Where do you get the form

Ask your attending physician for a DNR order form.

Who is permitted to request a DNR for themselves

Any “qualified” patient may request a DNR order. A qualified patient is anyone who is at least 18 years old and who either has a terminal condition or has a medical condition such that were he or she to suffer cardiac or pulmonary failure, resuscitation would be unsuccessful in restoring cardiac or respiratory function, the person would experience repeated cardiac or pulmonary failure within a short period before death occurs, or resuscitation would cause significant physical pain or harm that would outweigh the possibility the resuscitation would successfully restore cardiac or respiratory function for an indefinite period of time.

Who signs the form

The patient and the physician both sign the form.

Where do you obtain a DNR bracelet

In Wisconsin, anyone who has a DNR order must wear a bracelet to document this DNR. There are two types of DNR bracelets available to identify a person with a valid DNR order. One is a plastic ID bracelet which looks like a hospital identification. This type should be requested directly from the physician. It is free. The other type is a metal bracelet which displays the internationally recognized symbol of Aesculapius on the front and the words “Wisconsin-Do-Not-Resuscitate-EMS” and the qualified patient’s first and last name engraved on the back. It can only be purchased from MedicAlert for a cost as well as an initial membership fee.

Revoking a DNR

A patient may revoke a DNR order at any time by: 1) expressing the desire to be resuscitated; 2) defacing, burning, cutting or otherwise destroying the DNR bracelet; 3) removing the DNR bracelet.